Vietnam. Heroin Addiction - What We Learned

Merry Christmas, 2015

"Back in 1971, during Operation Golden Flow, it was becoming increasingly clear addiction was a brain disease and that an individual's biology, along with the genes he or she was born with, accounted for about half of their addiction vulnerability. But the other half was more complicated, a product of their environment and its interplay with genetics.
This is where Operation Gold Rush would provide some startling insights. One thing was clear: The soldiers returning from Vietnam were about to undergo a dramatic transformation in their environment."


Navigating Gender Non-Conformity // Transition // Growing Up Trans

I am often asked how a clinician can assist an adolescent through a gender transition.
 Of course, every path is unique - there's no manual on how an adolescent should navigate gender non-conforming  development, in other words, getting from point A to point B. There's not really a linear line for gender dysphoria.
The clinicians role is to by-stand and be a sounding board through the emotional and psychological struggles.

Remembering also that there is no end point. Wherever a transgender person chooses to stop in their journey, that is the destination, at least for the time being. A counselor cannot be invested in the final outcome. Much like the English-channel swimmer with support crews nearby, or the escort vehicle...just nearby enough to be a rational instrument, measured and steady.

Here are some typical questions I get: 

"How can you tell it's not just a fad the child is going through?"
"Do you persuade them one way or another?"
"Why is it so common now?"

The process is not as complicated as it sounds.
For starters, I do not push someone towards a sexual preference, or gender identity. 
And, I do not dissuade them against a preference or identity.
Frankly, either would be unethical and against my duties as a mental health clinician.

Step One: I listen.
Step Two: I ask questions.
Step Three: I ask, "how can I help?"
Step Four: We walk through "what if's?" together.
Step Five: I meet with the family and allow for all expressions.
 Believe it or not, most families are supportive!
Step 6: Refer to a local LBGTQI group (San Diego's Center)

It is normal for parents to be worried that their child or loved one will suffer as a result of a gender-changing decision: there's no getting around that reality. It is not an easy experience. 
Stigma DOES exist but society and culture have greatly changed in this regard.

If you are a young person struggling in this area, and feel rejected or unsupported, I urge you to contact a trusted friend or the Lesbian Gay Transgender center nearest you. Your life matters and there are people who can guide you and your family towards a solution.
Or, visit
If you are thinking of harming yourself, please call 18887247240 (it's free and confidential) 
  - Let a teacher, relative, or  neighbor know that you need to talk with someone who better understands your thoughts and feelings.

Most adolescents who are seriously considering a transition to the opposite gender have felt "as if" they were the opposite gender from earliest memory. They may have dressed gender-neutral... for example, tomboyish or feminine... 
Many try on "gay" only to find out that this label doesn't accurately fit.

Sexuality is different from gender identity...For our purposes here, there is no need to address sexual preference or orientation. 

When the earnestness is present, with a desire to further live, behave, and represent as this "different" gender, it is obvious to me and those around the young adult that this has been thought of for quite a long while and they are not being influenced by current trends or fads, as is often suspected.
Most teens are NOT craving attention. In fact, in my experience, their very worst fears relate directly to peers noticing, commenting, judging, or dramatically acknowledging the changes.  


Occasionally I will hear my adult peers say something like, "There was no such thing as this when I was growing up," (harumph, harumph) it sounds a lot like "When I was in the Army, no one was gay." Um...sorry but...

If you identify with your birth gender, ask yourself this question: "Would I have switched genders if given the opportunity?"  
My answer is, "Of course not!" No never crossed my mind. The likelihood that a young adult is pseudo - interested in an identity shift, for a protracted period of time, is minimal. With that in mind, I will also state that I typically find these kids squared away; in other words, not suffering from sexual deviance,  rebellious depression or maladjusted childhood. I cannot stress this point enough. The typical trans-child is clear-eyed, clear-thinking, and mature beyond their years.

Questions such as, "What has been on your mind?" or "What do you see happening next?" can inform you of exactly where the adolescent is emotionally, mentally, and psychologically. It is the therapist's job to simply provide the space for dialogue - not to drive the process. 

Often, the teen has one or two supportive friends who are "in the know." These are great allies, so invite them into therapy for a support session. It's a formal invitation to support the process to others.

I encourage teens to take baby steps, with the assistance and approval of their loved ones.
Because familial support is critical, I venture into this patient/therapist relationship ONLY with parental involvement. It would not be in the adolescent's best interest to engage in such a drastic change without familial support.   
All young adults need to learn how to assert themselves verbally, in a healthy and clear manner. This is a tall order but it can be done...guiding them into an honesty and openness with their parents, even in the face of fear and judgment. I work diligently to bring all parties on board before beginning a real outward transition - I believe this is safest for the client and creates the least inner turmoil

READ THE American Psychological Association on Gender Variance
For female to male (FTM), this usually looks like:
  • breast binding
  • deepening ones own voice intentionally
  • removal of all make-up, piercings and accessories
  • male sports activities, traditional masculine behavior
  •  male clothing (underwear, trousers, etc)
  • increasing body mass (weight lifting)
  • learning how to posture and "act manly" 
  • hair cut 
  • name change 
  • a preference for a pronoun change from family and friends (i..e, "she" to "he") 

Both surgical/medical therapy and chemical/hormonal (aka cross-sex) changes are between a physician and the child's family: I refer the patient back to his physician for medical treatment, if that is the desired outcome. 
Again, that is a lengthy process and not something I, or anyone else, jumps into quickly.  
However, in my experience, by the time I am working with a family, the transgender client has already done their own research on the topic and comes in with quite a bit of their own knowledge.
A slow-going, thoughtful clinician will simply allow the discussion and experience to unfold, without prompting, pushing, or stifling the process.
For male to female (MTF) transitioning, read here. 
As a clinician, I do not promise happiness on the other side of this process. I offer integration as a goal, but not necessarily joy, peace, or relief.   
For example, I would not say: "You will be so happy when this is over,"  "Your life will be better now," "This is what God intended," or "Let's not worry about what others think."

"Gender Dysphoria in Children refers to the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender.  Although not all individuals will experience distress as a result of such incongruence, many are distressed if the desired physical interventions by means of hormones and/or surgery are not available." Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Remember, it is a privilege to accompany a family through this experience.

  • Gender-non conforming children: Children and adolescents who exhibit behavior that is not typical of their assigned birth sex.
  • Gender-questioning youth: Children and adolescents who are questioning their gender identities (e.g., “I was born a girl, but I wonder if I’m really a boy?”).
  • Transgender and gender-fluid youth: Children and adolescents who identify as a gender identity different from their assigned birth sex (e.g., “I was born a girl, but I am really a boy.”).
For more info, read THE TRANSGENDER CHILD


Chicago Breaks New Ground With Gender Identity Clinic For Youth

From Monk to Model in Thailand BBC




Short Poem to a 15 Year Old Son

"Sweet little boy with big tasks at hand

Trying to become a young man

Acting like an asshole every step of the way.

I love you so very much"





Stress Management/Self-Care - Avoid Burnout

C.R.E.A.T.I.O.N.: An Acronym to Prevent Stress or Burnout

Proper stress management and self-care as outlined by Monica Reed (2007)

Rest - sleep and relaxation
Environment - nature
Activity - create without goal
Trust in Divine Power - any sense of spiritual support
Interpersonal Relationships - love and friendship
Outlook - optimistic hope for the future


San Diego Suicide and Crisis Hotline Referrals

San Diego County referrals: Access and Suicide Crisis Line & Substance abuse referrals. 1-888-724-7240 San Diego Sexual Assault and Rape Hotline 1-888-272-1767 Domestic Violence Crisis Hotline 1-888-385-4657  Spanish speaking suicide hotline: 1-800- SUICIDA (1-800-784-2432)